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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

Vishwas Joshi and colleagues from Seagull BioSolutions in India will develop a vaccine against the dengue virus by engineering a defective version of the measles virus to express dengue virus proteins (a so-called virosome), which can induce protective immunity. There is currently no approved vaccine that protects against dengue infection, which causes disease in 50-100 million people annually, some of which are life threatening. They will test the efficacy of the virosomes to prevent dengue virus infection by using them to vaccinate mice and analyzing immunity upon viral exposure. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

This project, run in collaboration with international partners Daisa Enterprises (formerly Wholesome Wave) and the McGill University Centre for the Convergence of Health and Economics, aims to pilot an innovative entrepreneurial approach to provide economic benefits and increase agricultural production, nutritional intake, and overall health to women in resource-poor rural and urban communities.

This is a proof-of-concept development for using viral agents to target and kill pathogens and odor-producing bacteria in fecal waste and also develop for ways to integrate this into waste treatment systems. The potential of this project is immense as, once thoroughly tested; it will provide a completely natural alternate to managing pathogens in waste water.

The proposal attempts to address the lack of a simple, low-cost, prospective biomarker for future short stature or stunting. It aims to validate the use of absolute neutrophil count as a predictor/biomarker for stunting in infants. It has been hypothesized that infants in settings with poor sanitation conditions and associated abnormal inflammation of the gut from infections subsequently have poor absorptions of nutrients and loss of supplements which eventually leads to stunting. Neutrophils are drawn to these sites of microbial colonization or are exhausted during the clearing of microbes from circulation. The study tries to establish the low absolute neutrophil count as a measure of mucosal inflammation and as predictor of linear growth in Indian infants.

Avin Agarwal and team will develop an electronic pill box with the software architecture based on a client-server software solution with hardware integration. The technique involves tracking the weight of the remaining pills through an electronic pill box with GSM connection and pressure sensor. This approach tracks if the pill is taken out of the pill box for consumption and reports this information to the central server. The solution could be as effective as DOT and a lot cheaper to implement. Addressing the cost of implementation will be emphasized for long-term execution, and an alternate SMS-based solution is suggested to reduce the dependency on pill boxes, in case the objective can be met using a less expensive SMS solution. By the nature of its design, the application will identify defaulters and escalate them for more stringent techniques of monitoring and at the same time alert healthcare professionals only when necessary.

Janardan Suresh and team are building a mobile-based application to improve TB adherence. The system, called TB Prasakti, involves SMS-based reminder and follow up, automated telephone reminder and follow up, and a total patient information system, which ensures maximum utilization of technology for TB. It provides for easy scalability and affordability and provides a "single window" to capture, store, remind, follow up and generate reports, thus ensuring a comprehensive and all-encompassing solution. The novelty lies in the solution being a total end-to-end tracking of the TB patient treatment and adherence life cycle, in which all the stakeholders are able to communicate through a single system.

Rohit Srivastava and Aravind Kumar of the Indian Institute of Technology, Bombay in India will develop a microneedle-based drug delivery system for the treatment of tuberculosis (TB). Current treatment involves frequent administration of combinations of toxic drugs, which often leads to non-compliance necessitating further complex treatments. They have designed a photo-thermosensitive nanocarrier based on liposomes that can release the drugs transdermally via microneedles upon exposure to sunlight or LED in a controlled manner, bypassing the need for multiple administrations and reducing toxic side effects. They will fabricate the microneedles, evaluate drug release dynamics using light, and test drug bioavailability in vivo using a small animal model. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

The study aims to assess the effect of depression on pregnancy and develop biomarkers for adverse pregnancy outcomes. It plans to analyze stress outcomes on pregnancy, fetal growth and birth weight. The overall aim of the study is to determine stress biomarkers for early detection of mothers at risk of preterm birth and intrauterine growth restriction (IUGR) and to develop interventions to reduce stress and reduce adverse birth outcomes.

Saleem Mohammed of XCode is developing a platform for publishing, through which "health signals" will be delivered. These health signals are delivered over a subscriber's mobile phone in a snack format comprised of a reminder system through SMS, a reply mechanism for confirmation, a 1-minute audio clip that educates about the disease, and a quiz for engagement and incentives to be awarded accordingly. The SMS acts as a teaser to the audio clip that expands and goes into greater detail about TB drug adherence. The technology is deployed in the cloud, which enables the solution to scale rapidly and dynamically. REAP TB also uses the services of TB survivors for counseling and following up with TB patients.

Shweta Roy and team are developing a small, electronic, tablet strip holder that enables real-time tracking of patient treatment adherence and inventory. The tablet strip holder will be small in size, embedded with a weighing scale to monitor change in weight of tablet strips and thereby monitor treatment adherence. Any change in the weight of the strip will be recorded on a server via SMS using a telemetric SIM within the holder. If the change in weight is not detected within a given time period, the device will trigger a non-compliance alert through SMS to the patient and caregiver DOTS observer. The holder will also have an inbuilt alarm to alert the patient in case of missed dosages. The final product will be light weight and sleek in design and the patient will be able carry the tablet strip holder like a mobile phone. Minimal patient input is expected, making this device user friendly, and alerts can be customized as per regional language. The cost of the final device is expected to be $10 - 12 USD per piece.

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